Aortic root replacement or wrap with AVR?

[AllForDad]

Hi everyone - I'm new here.

I am writing to ask people's opinions. My dad has severe aortic stenosis due to a bicuspid aortic valve (area 0.8). He also has aortic dilation of 4.7cm.

I am currently a nurse working in the Cardiothoracic ICU at Lankenau Hospital in PA so I see these surgeries everyday.

My question is this. Which of the following operations should he go with?

1 - I work with an amazing surgeon, Dr. Scott Goldman, who would replace the vavle with a stentless porcine valve and proceed with an aortic root wrap, in which he wraps the native aorta with the same dacron material used to replace. He wraps aortas anywhere from 4.5-5.5 cm dilated and believed in leaving the person's own anatomy in place. He would do the procedure through a minimally invasive 3-4 inch incision or the sternum using HeartPort technology which allows the heart lung machine to be connected through a vein in the neck and groin instead of connecting right around the operation site (hence allowing for the smaller incision)

2 - My dad also talked to another great surgeon, Dr. Joseph Cosselli, in Houston, TX. He believes replacement of the aneursymal segment is a better option. He would also use a stentless procine valve, however, he would do the full sternotomy.

Is anyone familiar with the wrapping of the aneurysmal segment??? Dr. Goldman was the first to use this procedure and he was also the pioneer or stentless valves. I'm sure either surgery would prove successful, any opinions??

My dad is 48.

Thanks!

 

[MrP]

Dr. Coselli performed my valve replacement and ascending aortic aneursym resection at Methodist Hospital in Houston, and I was very impressed with his expertise, experience, and surgical skills. I understand that he's one of the top three thoracic surgeons in the world. Therefore, I naturally am biased towards Dr. Coselli's position on this one. And I am not familiar with current techniques for wraps and know little about them, but I am pretty sure I read a few years ago that complete resection and replacement with Dacron was found in comparitive studies to be more long-lasting than wraps. I can't recall the research specifics at this time though...sorry. Maybe a more current wrap technique is indeed effective, and Dr. Goldman might be able to provide quantitative evidence to support his assertion. I think most surgeons prefer resecting the diseased aorta. When I think of the concept of wrapping the ascending aorta, I get a visual image of an ol' garden hose that has become weakened and bulged....repaired with duck tape. I know this sounds crude or sarcastic, but this is the image I get of a wrap. I just don't understand the advantages of a wrap vs. complete resection and replacement. A wrap seems intuitively to have greater risks and not long lasting. Maybe I am simply drawing upon my childhood experiences with a garden hose. Please share what you learn. The length of the incision should not be a major factor either way, although before surgery the thought of a scar is of concern. Best of luck to your dad in Houston!

 

[Magic8Ball]

I too have read that a 'wrap' is not the best approach as it can cause infections etc. It does not make the area any stronger to wrap as opposed to replace the offending section of aorta.

I have no knowlege of the doctor or the hospital but my understanding of what ive read on the subject prior to my surgery is that the 'wrap' is 'old school' thinking.

Regards.

 

[Tom F.]

I have also read that the wrap is not a good idea. You may want to do some research on the net for some more ideas, you may find an article or two that directly talks about this approach.

 

[Susan BAV]

Hi Allfordad -

What a great help to your dad right now to have you in the same medical field and helping him investigate this! Don't give up on your question but bump it up with a comment if it drops down the thread and others may see your thread and post with more specific information.

I don't know enough about either option to express any thought specifically about it -- sorry. But there is a website specifically with info on bicuspids with a lot of the latest known info related to bicuspids and connective tissue problems which are at least somewhat common with (some of) us. I think it's called Bicuspid Foundation. Search here to find the exact website (leave the space out between the two words).

My experience is not the same and I don't know if this is helpful but I have a Dacron graft from over 27 years ago for a coaractation repair; and when I was being examined prior to my bicuspid replacement three years ago, the doctors expressed relief, including some surprise, that the graft repair was still okay.

Best wishes to your dad for a safe outcome.

 

[Mike C]

I asked my surgeon wy not just tape (wrap) it. his response, "we used to, didnt work"

 

[Bradley White]

Maybe my wrap and the one your father are going to get are very different. But I had a pretty enlarged aortic root and got it wrapped. I got another anuerysm about 4 years later at the root.

Brad

 

[AllForDad]

Thank you to everyone who has responded.

We have decided that my father will go with Dr. Coselli in Houston and St. Luke's Episcopal. He is scheduled for next Wednesday the 31st, AVR and root replacement.

Again, thank you for the support.

 

[Susan BAV]

Hi AllforDad -

I hope all goes well for your dad! Hope you will keep us posted as your time allows too.

 

[temp69]

This may be too late, but I had a wrap from Dr. Laks at UCLA, and he's considered tops in his field, he's the head of the cardio unit and teaches at UCLA. The dacron wrap works and is strong. Can't get into the technical aspects, but google dr. laks and you'll see his standing in the community.

good luck!